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Antimicrobial Stewardship Initiatives Need to Focus on More Than Reducing Resistance Rates

It is evident that there is a need for greater commu­nity antimicrobial stewardship. Typically, these move­ments have targeted changing prescribing practices of the medical community and educating the public.2,3 The findings from Zoorob and colleagues indicate that community stewardship initiatives should include em­phasis on preventing self-medication with antimicro­bials and reducing dispensing without a prescription. Community antimicrobial stewardship initiatives for pharmacists should not just focus on the importance of reducing resistance rates, given that some pharmacists may be aware of this and do not see it is a discouraging factor.7 Important educational points for pharmacists should focus on patient safety and the legal aspects of dispensing without prescriptions. Education for the public should emphasize safe antimicrobial practices and focus on changing current attitudes and beliefs re­garding the use of nonprescription antimicrobials.
Alexandra Hanretty, PharmD, is a PGY2 resident in infectious diseases pharmacy at Temple University. She completed a pharmacy practice residency at the University of San Francisco Medical Center. She received her PharmD from Temple University School of Pharmacy and bachelor of science degree from Syracuse University.
Jason C. Gallagher, PharmD, FCCP, FIDSA, BCPS, is clinical professor at Temple University School of Pharmacy and clinical pharmacy specialist in infectious diseases at Temple University Hospital, both in Philadelphia. He also is the director of the PGY2 Residency in Infectious Diseases Pharmacy at Temple.
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2. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control. Emerg Infect Dis. 2005;11(6):794-801.
3. Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiot­ic-resistant infections: a call to action for the medical communi­ty from the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(2):155-164. doi: 10.1086/524891.
4. Zoorob R, Grigoryan L, Nash S, Trautner BW. Non-prescription an­timicrobial use in a primary care population in the united states: Evi­dence for action. Antimicrob Agents Chemother. 2016.
5. Mainous AG, Cheng AY, Garr RC, Tilley BC, Everett CJ, McKee MD. Nonprescribed antimicrobial drugs in Latino community, South Caro­lina. Emerg Infect Dis. 2005;11(6):883-888. doi:10.3201/eid1106.040960.
6. Larson E, Grullon-Figueroa L. Availability of antibiotics without prescription in New York City. J Urban Health. 2004;81(3):498-504.
7. Zapata-Cachafeiro M, González-González C, Váquez-Lago JM, et al. Determinants of antibiotic dispensing without a medical pre­scription: A cross-sectional study in the north of Spain. J Antimicrob Chemother. 2014;69(11):3156-3160. doi: 10.1093/jac/dku229.
8. Guinovart MC, Figueras A, Llop JC, Llor C. Obtaining antibiotics without prescription in Spain in 2014: even easier now than 6 years ago. J Antimicrob Chemother. 2015;70(4):1270-1271. doi: 10.1093/jac/ dku526.

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